CAHOHR: Study of Innate Host Immune Response to C. Glabrata Clinical Isolates Resistant to Echinocandins: Impact on the Management of Candidemia in High-risk Patients

Sponsor
Centre Hospitalier Universitaire Dijon (Other)
Overall Status
Unknown status
CT.gov ID
NCT03652194
Collaborator
(none)
21
1
17
1.2

Study Details

Study Description

Brief Summary

In the context of Candida yeast infections, a large number of studies have been published over the past two decades specifying the molecular mechanisms of antifungal resistance in different Candida species. However, few of these studies have explored how these mechanisms influence host immune response to this opportunistic pathogen. Recent advances in understanding how the host's immune system responds to Candida have initiated the emergence of a new research theme aimed at better understanding Candida's intrinsic and adaptive resistance mechanisms to antifungals can modulate "escape to" or "recognition by" the host's immune system. This knowledge could lead to (i) a better understanding of the predominance of certain Candida species with antifungal resistance in certain patient populations, (ii) a better understanding of why high levels of in vitro resistance are not necessarily correlated with in vivo therapeutic failure, and (iii) effective immunotherapeutic strategies to control Candida resistance to antifungals.

It is therefore crucial to investigate the impact of Candida's resistance to antifungals on the host's innate immune response. Indeed, most antifungal resistance mechanisms have a direct or indirect structural modification of the fungal wall. However, it is the composition of this wall that is involved in the recognition of Candida by the host cell via the pattern recognition receptors (PRRs). We therefore put forward the very probable hypothesis that changes in the fungal wall, induced by the appearance of resistance, could alter the recognition of Candida by PRRs and thus trigger a different immune response, either qualitatively (type of cytokines secreted) or quantitatively (amplitude and duration of the immune response). However, even if initial experimental data support the hypothesis of a possible link between resistance and a modulation of the innate immune response in digestive mucosa (the most frequent starting point for disseminated candidiasis), many questions remain regarding (i) the proteins and mechanisms of the modulated immune cascade, (ii) the modification of the immune response according to the Candida species in question and (iii) the modification of the immune response according to the resistance phenotype in question.

Condition or Disease Intervention/Treatment Phase
  • Other: in vitro evaluation of epithelial immune response during C. glabrata infection
  • Other: study of the impact of resistance phenotype acquisition on the virulence of C. glabrata isolates

Study Design

Study Type:
Observational
Actual Enrollment :
21 participants
Observational Model:
Cohort
Time Perspective:
Other
Official Title:
Study of Innate Host Immune Response to C. Glabrata Clinical Isolates Resistant to Echinocandins: Impact on the Management of Candidemia in High-risk Patients
Actual Study Start Date :
Jan 1, 2018
Anticipated Primary Completion Date :
Jan 1, 2019
Anticipated Study Completion Date :
Jun 1, 2019

Arms and Interventions

Arm Intervention/Treatment
Reference strain ATCC

1 strain sensitive to all antifungals

Other: in vitro evaluation of epithelial immune response during C. glabrata infection
study of the expression of genes coding for different proteins involved in the RTqPCR activation cascade study of protein expression by the Western-Blot method

Other: study of the impact of resistance phenotype acquisition on the virulence of C. glabrata isolates
in vitro evaluation by measuring cell invasion, cell adhesion and by determining epithelial cell cytotoxicity. in vivo evaluation measured by a survival study on a CD-1 mouse model.

Clinical isolates sensitive to all antifungal agents

10 clinical isolates sensitive to all

Other: in vitro evaluation of epithelial immune response during C. glabrata infection
study of the expression of genes coding for different proteins involved in the RTqPCR activation cascade study of protein expression by the Western-Blot method

Other: study of the impact of resistance phenotype acquisition on the virulence of C. glabrata isolates
in vitro evaluation by measuring cell invasion, cell adhesion and by determining epithelial cell cytotoxicity. in vivo evaluation measured by a survival study on a CD-1 mouse model.

Echinocandin-resistant clinical isolates

10 echinocandin-resistant clinical isolates (Eucast, Caspofungin > 8µg/ml)

Other: in vitro evaluation of epithelial immune response during C. glabrata infection
study of the expression of genes coding for different proteins involved in the RTqPCR activation cascade study of protein expression by the Western-Blot method

Other: study of the impact of resistance phenotype acquisition on the virulence of C. glabrata isolates
in vitro evaluation by measuring cell invasion, cell adhesion and by determining epithelial cell cytotoxicity. in vivo evaluation measured by a survival study on a CD-1 mouse model.

Outcome Measures

Primary Outcome Measures

  1. Quantification of accession and invasion [Baseline]

    In vitro study of different virulence markers

  2. Test SytoxOrange [Baseline]

    In vitro study of different cytotoxicity markers in digestive epithelial cells

  3. Quantification of the gene expression of the various cytokines associated with the immune response in digestive epithelial cells. [Baseline]

Eligibility Criteria

Criteria

Ages Eligible for Study:
N/A and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • 10 clinical isolates sensitive to all antifungal agents

  • 10 echinocandin-resistant clinical isolates (Eucast, caspofungin > 8µg/ml)

Clinical strains of C. glabrata susceptible or resistant to echinocandins will be selected on selected criteria:

  • patient's immune status

  • therapeutic management

  • clinical developments

Exclusion Criteria:
  • Not applicable

Contacts and Locations

Locations

Site City State Country Postal Code
1 Chu Dijon Bourogne Dijon France 21000

Sponsors and Collaborators

  • Centre Hospitalier Universitaire Dijon

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Centre Hospitalier Universitaire Dijon
ClinicalTrials.gov Identifier:
NCT03652194
Other Study ID Numbers:
  • Basmaciyan AOI 2017
First Posted:
Aug 29, 2018
Last Update Posted:
Aug 29, 2018
Last Verified:
Aug 1, 2018
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Additional relevant MeSH terms:

Study Results

No Results Posted as of Aug 29, 2018